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Tuesday, August 16, 2011

Ob/Gyns are terrible people who need to die, and other common misconceptions

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.

I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (God forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, the media, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

Seriously, though :) Aside from the one story I related in my last post, my experience as a *patient* with female ob/gyns has been very positive. The one I have now (even though she made a recommendation that I might not agree with and the wait for appointments is maddening) is the sweetest woman ever. And I respect ob/gyns more than any other specialty, because you guys have a really hard and noble job. I get so angry when people supporting homebirth start talking smack about how obstetricians are so evil.

But yeah, I really felt abused by the residents during my ob/gyn rotation in med school. I've never been treated so cruelly on a rotation. There were residents I worked with on other rotations who were clearly miserable, but nobody got mistreated like the med students on ob/gyn. To the point where the clerkship director had to gather all the residents and tell them they were going to be in big trouble if they continued treating us that way.

That's the part I don't get: the inconsistency between the wonderful ob/gyns I've had as a patient vs. the horrible experience all med students seem to have.

Beautiful post. I always appreciate reading posts from doctors that defend their profession and explain some of the stresses associated with it. Coming home after my own terrible, horrible, no-good, very bad day, it's good to hear that I'm not alone in the medical world.

I have never commented on this blog, but wanted to give my two cents on this topic, and on the metamorphosis so many of us take when we enter into residencies.

My perspective is that of a former Ob/gyn resident. I decided after my first year of Ob/Gyn residency that I wanted to change careers, and am now happily an anesthesia resident after finishing 2 years of a grueling Ob residency where I had a total of about 5 weekends off over my residency span. I was a part of a wonderful program with excellent training, but was so miserable it wasn't until I finally had my head above the water that I could look back and see just how far I had sunk.

I think part of the problem with Ob/gyn physicians lies in the training. It is miserable. Laboring patients these days seem to fall into a few categories in residency training programs:1) Women who are normal, healthy, realistic about labor and deliver a normal, happy, healthy baby: ~30%2) Women who come in with the dreaded "birth plan", doula, birthing ball, what have you and with the misconception that all obs are out to cut/offer them pain medicine/perform unnecessary interventions: ~15%3) Women who are very unhealthy, diabetic, morbidly obese, grandmultiparous and at risk for a million and one complications: ~30%4) Women who are healthy and everything goes to crap in a second (intrauterine fetal death, fetal acidosis resulting in long term complications, extremely preterm labor, etc): ~15%5) Women who come into labor high on meth/crack/marijuana: ~10%

Each one of those scenarios, with the exception of 1, is mentally and physically draining. Being up all night with all of those scenarios happening all at once, multiple nights a month for most months out of 4 years, is absolutely exhausting. I watched so many residents fade into shadows of their former selves during my few years there, and now that I am on the other side of the curtain, I see it continuing to happen. It seems like even when residency is done, some of them still have that "bitchy" side that only came out once they were ingrained into the residency program.

I agree with a previous commenter that litigation is also a problem. Lack of adequate surgical training and volume also makes the gynecologic part more stressful then it should be. Gynecologic oncology can be rewarding, but also so sad as many of the patients are relatively young. Ob/gyns are expected to be primary caregivers (routine health maintenance, pap smears, mammograms, etc), surgeons, and obstetricians and are just expected to wear too many hats. I struggled endlessly with the fact that for my own child, I wanted to my obstetrician to be there for the delivery because I really liked her and I knew her. So how could I expect my patients to not want the same thing? How could I chose between delivering a well-known patient's baby or attending my daughter's swim meet when both events are so important in each of their lives? I don't know how Ob/gyns do it without an endless amount of guilt on both ends, and thus I would think bitterness would be inevitable.

That all being said, I had such wonderful people where I trained that I know there are so many great MDs out there who are perfect for the field. I don't know how they do it, but I respect them immensely. When I left, the majority of people I talked to said they wouldn't do anything else, despite being a little bitter about things. I hope everyone has an Ob/gyn in their lives that they can trust and turn to, as I think the field is so important in so many ways.

Fizzy~ I had a good Ob experience as a student (very big, busy L&D), but our residents were so busy (read, no coddling, no teaching, no hand-holding) they needed every hand they could get. We did all of the "normal" deliveries with the midwives (CNMs), the residents were in the OR most of the day. When we did deliver with the residents, they totally left us on our own to suture lacerations/episiotomies, et.cetera. Sink or swim! Scut was the name of the game when I was a student, it didn't really phase me, I never felt that it was malignant. When I was a resident (smaller program with more "private" type patients), I think it could be frustrating for students, because our patients often wouldn't want a resident touching them, much less a student, so they didn't always get to do much at delivery. No fun! We did try to teach, and we would ask them to go get food on call (when nothing was going on), but we bought their dinner if they did it, none of us could go off campus, and the hospital food sucked!

Solitary Diner ~ Thank you. It is always good to know we are not alone out here. :)

Out of sincere interest, what does being "realistic" about labor mean to ob residents? I really wanted a baby to come out of my vagina, but it did not. Things felt pushy. I'm assuming I was being unrealistic, but I felt like there was an under-appreciation for the fact that this was a really big deal for me.

My dad is a neonatologist. My ex, who was in med school at the time, wanted to do OB - loved the thrill of labor. Dad encouraged him not too, based on watching the careers of his classmates and the OB's he worked with. The devastating, often unfair lawsuits that destroy their love and ability to do OB. The burnout. My ex went into anesthesia. My dad defends OB's in the courtroom - has for years.

I too had bad experience, like Fizzy, with female OB residents as a med student, with the exception of one. I felt like I was the unpopular girl in high school again. My OB is female - had her for 9 years. She is the most calm, even, wonderful person. I consider her a friend, but I am a little starstruck by her whenever I see her, even though I am a colleague. We laugh, she listens, and she calms my fears and answers my questions intelligently and thoughtfully. I have referred non-medical field friends to her and she treats them the same way - they worship her as well. Although I can tell she is not the kind of person who would treat doctors better, it is reinforcing to get this feedback from my peers.

I don't even know you, but I gotta say, you're my new hero. You have put into words every single thing I think about when I picture what it will be like to be an Ob. And for that, I am grateful. All women that dislike Ob's should read this post.

I took my first call since delivering my first-born 12-week-old last night, so this post really hit home. I love my job. I never thought I wanted to be an OB/Gyn (who dreams about that growing up?!), but after my first few months of medical school, I wasn't interested in anything else. Damn me. I also practice in an amazing community and have even more amazing partners. And despite having a reflux-y baby at home, I actually slept last night. But whenever I'm on call, which is weekly, I have reminders about why we are a bitter group.

For me, it has little to do with the economics of it. I know I could work less and earn more in some other specialties, but I honestly don't care. I know my malpractice premiums are ridiculous, but that alone isn't enough to make me upset.

What upsets me is the way we are treated by others, both our patients and our colleagues. Last night is a prime example.

Around 1830, I fielded a call from one of my regular patients wanting to know if her birth control was causing the anxiety attacks she had been having for over 2 weeks. So many things wrong with this conversation, the primary one being that as a "primary care" doctor, my life is being interrupted after-hours by a problem that has been going on for 2 weeks. I suppose I could have declined to take the call, but that surely would have had affected my reputation in the lay community. And I'm sure I'm not the only reader of this blog who has fielded calls at 0200 on a Sunday from a patient who very sweetly apologizes for calling so late and then asks how to use her over-the-counter yeast infection cream because she lost the instructions (and you say that it's no big deal since you're still up anyway).

Of course, I was sitting at the hospital twiddling my thumbs when that call came in because OB is one of the few specialties that hospitals deem so dangerous that nurses can't administer medications we prescribe routinely. Specifically, if a patient requires prostaglandins for labor induction at my hospital, I have to place the first dose myself. Of course, labor induction is not an urgent procedure, so the pharmacy sees no need to get me the medication my patient needs. As a result, I sat on L&D for 2 hours waiting for the pharmacy to get its act together, in the meantime, missing my opportunity to see my baby before he headed to his grandparents' house for the rest of his waking hours. Chemotherapy can be administered by the nurses without a physician present, but Cervidil cannot. The oncologists can order routine, toxic medications remotely; I cannot order a medication that is essentially an analogue of a chemical that is naturally produced by the human body. Our institutions apparently think our decision-making is too haphazard to support, and our families suffer as a result.

However, what is worst, as far as I'm concerned, is the lack of respect we get from other physicians. This morning around 0500, I was hung up on by a female emergency department physician. I agreed come in right away to see the patient she thought might have an ectopic. I don't know if my comment that I didn't think it was an ectopic annoyed her--what I meant was that she didn't need to call the OR team in--but I nearly broke down in tears on my way in. I realize it's my job to see those patients, but not saying "goodbye" or "thanks" is the ultimate disrespect. Wrapping up the conversation is the least you can do when you're waking up someone who is likely sleep-deprived to begin with and doesn't get to go home after an 8-hour shift. These moments make me feel like people see me as a puppet, as if the ED doc was qualified to determine that the patient required surgery and that was I was just there to do the deed.

And, no, it was not an ectopic.

And she didn't have to have surgery. But perhaps in standing my ground, I got called some unpleasant names. Just another night on call....

Very nice post. In med school I had a decent experience on my OB/GYN rotation. I liked learning the material but didn't like the actual clinical practice. I am not a fan of performing surgery and do not like to be in the OR. The residents I worked with were very nice although I heard horror stories about some of the residents that I didn't work with. I got lucky in that department.

I've always had female OB/GYNs. I've never had a problem and I love my current doctor. I do have to wait up to an hour sometimes but I always try to give her the benefit of the doubt. I know she is working hard and OBs can't really predict when a patient will be delivering. I really came to appreciate this when I gave birth at 4:50pm on a weekday after two hours of pushing...and my OB was there the whole time. Back at her office the patients were piling up I'm sure.

Both Dr. Whoo and Marce have done done a great job of explaining the crazy, strange world of OB/GYN.

I have to make a daily decision to not let myself become bitter. I try to focus on the positives;on the things that I do that allow me to truly make a difference.

As hard as I try not to practice defensive medicine or focus on lawsuits, there are constant reminders in our newspapers and journals of multimillion dollar verdicts. I saw one today, where an OB misread an US and a baby was born with down syndrome. The OB was liable for $3 million dollars.

I thought my senior residents were mean and bitchy when I was an intern. When I was a chief, I realized, that while a few of the things were unnecessary that they did; most things that at the time seemed awful, were just them attempting to get all the massive amount of work done in their own bitter sleep deprived state.

It is hard to leave your favorite patient in labor, miss your sons first day of school or look into a hopeful patients eyes and tell them that their is no heartbeat. These things do not get easier with time, but you learn to cope with them without guilt.

At the end of the day I love my job. I consider it a privilege to be involved with each of my patients birth. The minute it becomes just a 'job' that's when its time to hang up the stirrups.

What? You mean you didn't work endless hours giving up time with your family and denying yourself things that everyone else would consider routine (like going to the bathroom), just for the opportunity to torture women and put babies in danger?

I know some people (in all specialties) don't deal with stress in the most productive way. And some people (in all specialties) are just jerks. But my experience in med school and as a patient, is that Ob/gyne is like any other specialty where the physicians are working to the best of their ability in the interests of their patients.

A beautifully written piece. Thank you OB-Gyne Kenobi for explaining again why doctors are as human as everyone else. My husband is in Critical Care and your post could just as easily explained his mood as any OBs.

Never had a female OB/GYN or any other doctor - not for any particular reason, just kind of worked out that way. But it seems like the male OB/GYNs carry similar cynicism... which I still (truthfully, even after reading all of the above do not understand). I work as a nurse in the PICU and with many critical care attendings, fellows and I just don't see them talking to our parents the same way my OB talks to me. Yet, somehow, I think their hours on call in house and with patients could match in intensity of work and time commitment to that of an OB resident (I dare say). Clients are different: not ALL women, but sick children and their parents, but who said that's easier?

I have learned quite a bit working in the PICU when it comes to personal communication methods and trying to understand other people's reasons for being demanding, rude to nursing and medical personell, and granted I don't know what patients think of me, but I can definitely echo the sentence about "building a wall" of sorts to "better protect ourselves" because I have found it works best for me, not only for my own internal psyche, but also in being politically correct, straight and non-emotional with my patients. Although I sure hope I don't sound like that to my patients. :( But alas, I probably do. And then we'll go around in full circle and some parent or med student is going to write a blog about "that bitchy" nurse who was callous to me.

Oh and Dr. Whoo (sorry for writing all of the above and actually NOT writing what I meant... my labetalol is fogging my head!), thank you for the post. I actually do like my OB (who is male, as I've mentioned), he is an awesome physician, I'm just trying to figure out his quirky personality, but it sounds like it has to be quirky in order to tolerate the screaming, demanding and unreasonable women (at times) in order to function as a normal human being. In my nursing school rotations, L&D started as my goal and ended with my least favorite. Sorry, couldn't work with the patients you work. My hat goes off to you. Big time.

I'm sorry you had a bad day (love that book). I had a good experience on ob/gyn as a med student, almost went into it but then realized that while I loved delivering babies, i really liked the complicated medical issues (call me crazy) more than surgery and preventive gyn care. Residents were generous about letting me help with stuff, the attendings were admirable and supportive. I just want to say that i am eternally grateful to my ob practice - saved the life of my first born who was totally unexpectedly in major distress when he was born, and they were attentive and responsive and caring the whole time he was in the NICU. They have gone on to be attentive, supportive, great listeners through 3 subsequent pregnancies, one ending in miscarriage, one still cooking. yes, there have been things that have not been perfect, but i would never have expected perfection, and i think things are harder for ob/gyn(more call, liability, etc. etc.). so, although I'm certain I've not been your pateint or med student, i just want to say thank you. it makes me sad that you had to even write this post.

The residents on my ObGyn rotation were split. The good residents were some of the best I had on any rotation. The bad residents made me want to walk into oncoming traffic. The bad ones were the mean girls from high school. Like Gizabeth said, they made me feel like I was the unpopular girl in junior high. The only way you could win on that rotation was a) to be a hot guy, b) be completely silent (though I suppose they'd have accused me of trying to sneak away if I'd done that), c) know everything already. None of those were options for me.

Unfortunately, this impression I got from my ObGyn rotation has followed me as I have see ObGyns since then. Mostly I've had good experiences as a patient, but every time I see one, but I'm still terrified that they're like the jerks I worked for on my rotation.

I find it interesting that Dr. Whoo says that it's the patients that make ObGyns miserable. My observation was that the residents made each other miserable. Not once did I see a resident cry because of something a patient did or said. By contrast, I often saw residents cry because of being berated by their residents.

Great post! I am impressed with your thoughtful response despite having had a rotten day and I imagine that you exercise that ability (to respond eloquently while irritable) frequently. Regardless, I appreciated what you had to say and admire you for all that you do.

Surgical type residencies are difficult and grueling and OB/GYN fits right into that.

I HATED my OB rotation. My father got extremely ill during my rotation (which I disliked even before this) and when I called my resident, they were kind but said I had to call the director. He basically told me that "oh,sure, your dad is sick". When I called to tell him I'd be gone a little longer because my dad had passed away, he was again quite callous. I told him I'd "bring the f'ing death certificate and I'd expect an apology" he never said another word. I was of course worried I'd get in trouble, but I suppose he was afraid my side would come out.

I've had nothing but good experiences wtih my OB/GYN's as a patient, thank goodness.

I'm sorry that you had such a bad day, dr. whoo... and then you had to read some of the commentary. I have days where I read commentary about physicians in general and get so upset. Sad that a few can taint the entire profession, be it OB/GYN, medicine, surgery.. whatever. Hope today is better.

Dr. Whoo: I was just reading your post again in the light of day and I wanted to say that I apologize if you took anything I said as a jab at your profession. I definitely didn't mean it that way. I won't take back what I said about that one specific doctor who happened to be an ob/gyn because I really disliked her, but as you know, there are doctors in every field who are bad at communicating.

My experiences as a patient these days mainly involve ob/gyns, so obviously those are the docs I'm going to talk about. But like I said in my first comment, I have the utmost respect for the specialty, and I was constantly defending ob/gyns in the pregnancy communities I joined. I'm really sorry if anything I said came off as an attack on you or ob/gyn. I think you guys are heroes.

While I do honestly believe that some medical specialists get paid more than they're worth, I would never say that about OB/GYN. You guys deserve every penny and you have my admiration. --full-time pediatrician

Dear Dr. Whoo - I applied for the match in OB and surgery however decided after applications were sent that I definitely wanted to do surgery. However, that said, I was one of the those medical students who enjoyed my OB rotation, and my med school was one where even as students we had lots of autonomy and worked really hard. I ultimately decided not to do OB for some of the reasons you listed after talking with some people I trusted and because it started to become clear that I really loved surgery.

However, as a shout out to you, I will say that my experience with my recent pregnancy was phenomenal. The OB's at my practice were amazing - I looked forward to going to my appointments. They watched out for me as a surgery resident and were ready to fight for me if need be to make sure I had a healthy pregnancy (I had a bedrest threat pretty early on). They encouraged me as a surgical resident. I truly felt that we were partners. Ironically, the only person in the practice I didn't like was one of the two males. I am very grateful to these wonderful doctors who took care of me and my baby. I know you hear lots of bad stuff about OB's, so I hope this can counteract it, if only a little!

Dr. Whoo, I am very sorry that you felt that your specialty was being attacked. Being a physician myself, I never life hearing any doctors attacked.

I do, however, want to add that much of the explanation that you gave in response to why OB/GYNs are often snappy or downright rude could easily apply to any physician. As an anesthesiologist, I often deal with pregnant women (meaning I also treat two patients at once). I work busy, busy call just as often as the OBs in my hospital and the work I do on call is extremely busy and very high stress. Even on a regular day where I supervise residents, I often do not have time to sit down or eat. I deal with OB nurses and OR nurses who think that they know how I should do my job. I also have children at home with whom I would like to spend more time.

All of that said, I DO NOT treat my residents and clerks the way I was treated by the OB staff when I was a clerk/ PGY-1. I do not snap at my colleagues and I am not unprofessional or disagreeable in the way that many of the OBs that I have worked with are. I have never once witnessed an anesthesiologist exhibit behaviour as deplorable as many of the OBs in the various academic and community hospitals in my city.

I have often wondered what turns lovely people into unkind OBs. Many of my friends are now OBs and I have seen inappropriate behaviour from many of them throughout their training and now practice. Is it the training system? I do not buy your argument that the nature of your work explains away the 'snappish answers, snarky humour' etc. My work is no less stressful and I manage to treat my colleagues and learners with respect, as do my colleagues.

Now clearly not all OBs have frequent moments of bad behaviour, but it seems clear to me (as someone who works with surgeons on a daily basis) that the rate of inappropriate interactions are higher with OBs that with other surgeons or any physician group I know. I think that, as a specialty, this needs to be addressed at both the training level and beyond.

Dr. Whoo - amen to everything. I'm a resident in internal medicine, not ob/gyn, but I think that a lot of what you said resonates across the specialties. We're judged constantly by people with very little understanding of the circumstances under which we work.

To the anonymous anesthesiologist - do you really think your lifestyle is as bad as that of an ob/gyns? I seriously considered anesthesia in med school and in general the anesthesiologists I talked to seemed to feel that it was somewhat of a controllable lifestyle specialty. No ob/gyn I talked to claimed the same.

All hail the OB/GYN. I'm not a doctor (alternate professional field... the dreaded lawyer) but I appreciate you and your colleagues like mad.

I'm on my fourth pregnancy. All three of my children were delivered by my OB/GYN, who yes, has a bit of a snarky sense of humor and is a bit pushy, but I LIKE her that way, and I'd never want someone "nicer". She knows her stuff, I don't. She knows when I'm pushing it too hard and will tell me to cut it out, and BECAUSE she's not wishy-washy and nicey-nicey, I listen to her where I wouldn't listen to someone else. She's confident. I need a doctor who tells me what to do, because she knows better than I do. I have enough of my own crap to worry about, I want basic respect and knowledge, and that's what I get. I don't want to "hear all my options for care", I want to trust someone to know what's best for me. She's never come even close to steering me wrong.

Plus, she's a super-amazing person who owns her own practice, has two kids, just bought this gorgeous house, and is sort of a role model for me as a working mom, because what she does is WAY harder than what I do. She's about five years older than me and her kids are about five years older than mine. Plus, I want her wardrobe.

Anesthesia in Canada (where I practice) is a busy, stressful, fulfilling specialty. So is OB/GYN. I am baffled by those people who say that Anesthesia is a 'lifestyle specialty'. Those people are universally not Anesthesiologists and have little in the way of understanding of what we do.

That said, I like my job and I take a great deal of pride in treating my learners and colleagues with respect, no matter how exhausted or overworked I am.

Giz, KC, Dr G, RH +, Melissa, med neophyte, AnonOBwiththeawfulcall, VIPeds, K, OMDG, mom of two doc, Kellie, Cutter, C, anon pediatrician, Lindsey, and Fizzy! (and anyone that I accidentally missed when scrolling) Thank you all for your incredibly supportive comments (and commiseration!) Today was a better day (even helped a patient get a vaginal delivery after prepping for a possible cesarean for stalled induction, yay!) I suffer no delusion that what I describe is unique only to Ob/Gyns, or even only to physicians, for that matter.

Fizzy, no need to apologize, there were several comments, including Tempeh's above that had a cumulative effect. For my fellow Ob/Gyns in training and in the trenches, keep on keeping on. Most days are good days, and all days are better than residency.

As for the anesthesiologist from Canada, no doubt, anesthesia shares many of the same stresses of Ob. You have a few major advantages, however, 1) Your patients are asleep for the majority of your interactions, and you often may never see them again after they leave the hospital2) *No office* (no office schedule, staff, overhead, etc.)3) You are not often the bearer of bad, horrible, devastating news. Over, and over, and over.4) Wider and more varied patient base, this can be a blessing and a curse.

As for the general attitude, (deplorable? really?) Maybe, because it is a surgical/procedure based specialty, it attracts "no nonsense" surgical-type people. Assertive, confident, when they are men. B*tches, when they are women? I know I have to consciously sweeten my tone often so as not to be perceived as being "angry" (I am not) when I am just being "matter of fact" (or concentrating). This has been addressed on this blog before, as well.

Dr. Whoo, I sense that your original post was written to elicit sympathy and to justify bad (yes, REALLY, occasionally deplorable) behaviour that OBs tend to engage in more frequently than other physicians (worse, even, than other surgeons, male or female).

I am sorry that you feel attacked. It is not pleasant to be misunderstood or misrepresented. I do think, however, that it is worthwhile thinking very critically about what you write. Consider whether there is some truth in the original supposition that OBs are overall more bitter and poorly behaved. Why is this so, when your job does not differ substantially in difficult elements to those of many other physicians? Is this fact something that should be addressed or should more excuses be made?

Additionally, it is a reflection of a lack of understanding that you think that the majority of an Anesthesiologist's patient interaction occurs when a patient is asleep. You obviously know how much time we spend with AWAKE women in labour or having C-sections. No doubt you are also familiar with the increasing use of regional anesthetic techniques in various surgeries and acute and chronic pain work that Anesthesiologists do. All of this on AWAKE patients. As well, many of those of us who do pain DO have offices and we follow patients on an ongoing basis. Finally, in Canada at least, many Anesthesiologists also do critical care. As you might imagine, this involves breaking bad news on a regular basis.

Dr. Anesthesia~ Your sense is wrong. I had no wish to garner sympathy in any way. Your supposition and instruction to "think critically" is quite insulting and pedantic (and part of the problem of which I speak). Tempeh asked, some of the other comments stung, as well, I opened up a window and poured my heart onto the page. I can only speak for myself, and can't speak for those you find "deplorable." I was never purposefully personally cruel to a student, nurse, or fellow physician. My attendings in training never treated me poorly. My fellow residents had both good and bad people, much as I suspect many other residencies do. Others (obviously)have had different experiences. I will say that the culture of residency favors constant motion and anticipating 3 steps ahead, not conducive to all med students' learning styles.

The bitterness (I agree, it exists!) comes with burnout, and with OB, the burnout is high. How could burnout be "addressed?" The demands of the job cannot be changed. Resident hours can't be cut any more than they are, training is marginal as it is. That's what I was trying to convey. Period. I don't know why we are burnt out and anesthesiologists/hospitalists/family physicians are not, because I am not one. I can only posit theories from my own point of view.

If you don't wish me to feel attacked then stop re-directing the original point. Apologies for the incorrect generalizations about your specialty, (ahem). I do not practice in Canada, and *in my area*, anesthesiologists who do pain management do not generally do OR, and those that do OR do not to pain management, few do critical care other than rapid response, nor do *any* of our anesthesiologists sit with any laboring women. They do sit with our C-section patients, and that is a great thing for the women when they can't see beyond the curtain.

Maybe in your area all OB/Gyns are the absolute spawn of Satan and you find it unfathomable that we could be otherwise. I would say if you asked my colleagues, L&D and OR nursing staff, and patients, not a single one of them would say I was inappropriate, mean, rude, snarky (to them), or deplorable. Because I'm not, in a professional setting, I act professionally. As, I'm sure, do you. Perception, however, is reality. It appears that we vary greatly in our perceptions of reality, so let us agree to disagree and bid one another good day.

I am neither OB or anesthesia, but have friends in both fields. My observation is OB field is more stressfull for multiple reasons cited by Dr Whoo. People who do primary care tend to have more emotional burn out, surgical specialties have more physical/sleep deprivation burn out. And OB's do both. We have to be grateful for everyone in OB field. They are doing it while many of us cannot. Thank you, Dr Whoo for the work you do.

JD~ Thank you, and no,that wasn't what I was indicating! Of course anesthesia is a valid specialty! I was apologizing for making incorrect generalizations about the specialty , and virutally clearing my throat (thus indicating I was open to the same ;) ).

Thank you, Anon 11:56 for articutlating in a more clear way what I was trying to say above. I appreciate your kind words. :)

To the Anesthesiologists,I am curious as to your thoughts as to why you feel your profession has less nasty people and more happy ones. Could it be that your overall interaction w/the general public is less than some of the primary care professions? Or for the perceived lifestyle? I know that many colleagues in med school who went into anesthesiology or in residency who chose to leave IM or Peds for anesthesiology did it specifically for the "lifestyle" benefits or for the lack of awake patient interaction.My experience w/ anesthesologists (for childbirth as well as cancer surgery on my neck as a teen) were not very extensive. I spoke w/ the anesthesiologist for less than 5 minutes each time and for my 2nd child I mostly got grunts in response to my questions (I was told that he was being particularly verbal for me).I am truly curious as to your thoughts. It seems to me that those professions that have less awake patient interaction have the least amount of burn-out in medicine (i.e. radiology, pathology, anesthesiology, etc).

It always makes me upset when I see articles and hear stories about how OB/GYNs are so awful/mean/in it for the money/don't know what they are doing. It must be like a slap in the face after all the training and sacrifices they make for their profession. That alone would be enough to make any person "snarky" and unpleasant to be around at times. Which I'm sure is the case for all kinds of specialities (my husband, a orthopedic PA included :) ).

I'm just a soon-to-be nursing student but have been through a lot with my OB/GYN and can respect everything she has on her plate. She's taken the time out of her schedule to just sit and cry with me through my 4 miscarriages. She's taken the time out of her day to call me directly and answer any of my questions. She's taken the time out of her day to schedule an evening ultrasound just so she is the one to do it and not a tech. During all this she is getting behind, probably missing lunch and dinner with her family and many more things.

I will always have the utmost respect and admiration for our OBs. Many people acknowledge how easy and happy their patients must be but there is a different side to their job that they handle with grace, kindness and strength and I'm sure it is not without a price...

Thanks for being you Dr. Whoo! Although, not everyone acknowledges what you do, there are some that will always remember what you've done for them.

As a fellow ob/gyn, I wholeheartedly agree with dr. whoo's comments on reasons for why those in our profession might appear "bitter". However, given the forum, contextually I interpret this to mean how we appear to our non ob physician colleagues, rather than being a comment on our professionalism. I can neither refute nor validate the opinions previously voiced by the Canadian anesthesiologist, but I don't think in the US it is generalizable that ob/gyns are seen as rude, unpleasant and unprofessional to their physician, nurse, PA, NP, or CNM colleagues, support staff and patients. I am sorry she has had that experience, but I don't think a mature individual, physician or other profession, would behave inappropriately or unprofessionally and expect any eloquence to excuse it. I think it is a misapprehension to think that discussing this topic of "bitterness among ob/gyns" was ever meant to excuse reprehensible behavior. An attitude of "bitterness" has the connotation of more expressed frustration and less satisfaction with the outcome of our choice of specialty rather than to a lack of regard for humanity (although God knows we get impatient with some members of His creation at times!) That said, although I struggle to have it all work out with marriage, 3 kids and a demanding profession I follow the Golden rule in my interactions and take full responsibility for same. And unless stated otherwise, I would have no reason to assume any less from the contributors to this blog/forum.

I would agree entirely with the previous poster's comment. For your call week and schedule, you make a good money as well. and you should take responsibility for your career choice and not take out frustration on people who pay to see you,

I am a s\w engg who has forgone a hefty salary in downtown chicago for a job near the suburbs offering flexibility so i can spend more time with my family

i had student loans, work experience still i choose to make 70k when i can make upwards of 110k instead of making 110k and being bitter and rude

I am an older pre-med and have been interested in ob/gyn based on the caliber of the doctors I've seen. My ob and gyn doctors have taken the most thorough histories and given me the best primary care of any doctor I've seen. This forum (don't worry - not this particular thread) has me wondering if ob/gyn is really right for me because I am not as interested in surgery as primary care. But learning more about what ob/gyn training involves leaves me even more awed by the wonderful doctors I've had over the years. It sounds like a few bad apples are fouling up the place - but the majority of you guys (guys and gals alike) are heroes AND good, patient, caring doctors.

Yikes! Looks like I let the genie out of the bottle and then left the premises. Dr. Whoo, totally sorry if my comments were offensive. As I'm seeing from your post (which was really eye-opening) and many of the comments from others, I had a very neatly packaged view of Ob/Gyn...a little medicine, a little surgery, healthy patients, new pink babies...what's not to love? I guess all of the other issues, most notably the concerns about malpractice and the unpredictability, are largely things I've had no reason to witness. Anyway, to echo what others have said, I have a lot of respect for what you do. I have 3 healthy kids that were brought safely into this world by 3 different obstetricians, and that means the world to me. Thanks for sharing and hope it was at least a little therapeutic to purge what sounds like a very tough day.

As a non-OB/GYN resident, I understand and appreciate the stress, hard-work, and under appreciation of those that work in the field. I briefly considered a career in OB/GYN, but was dissuaded by multiple people in the field during my med school rotation. I thought it foolish to disregard their advice, and ultimately, I'm glad I kept looking because I work in another area that blends medicine and surgery that I love. But when residents and fellows tell you *unsolicited* that they are unhappy with their career choice, and even attendings say they would have picked another field of medicine knowing what they know now, it leaves an impression. The system is broken, and it grinds on those willing to put themselves in the line of fire. I hope there is an increasing trend towards laborists (like hospitalists), better work hours, and improvements in the litigation system so that OB/GYN gains more attraction for future MDs (and improves the lives of already existing docs).

Anon @ 3:21 – It sounds like you may have experienced somebody, whom you have paid to see, taking out their frustration upon you. Please know that nobody here is excusing such a thing.

Your comments illustrate the very reason why this blog was created. It isn't a fault that neither you nor anyone else outside of this strange subculture cannot truly understand our experience. It's just a fact. There are physical therapists, engineers, PhDs, nurses, CRNAs, attorneys, teachers and countless other professionals who have abandoned their first careers and sought a second in medicine. Ask any one of them and they will gladly tell you how impossible it is to compare the course of medical education and subsequent career with any other profession. They will likely say they thought they knew what they were “getting into” only to find they had no idea! That isn't a "we work hard and nobody else does" comment, just one of fact. The insistent weight of day-to-day being responsible for the safety and well-being of others' lives, the unavoidable and inescapable exhaustion, the demoralizing and spirit-trampling training, the relentless second-guessing of one’s self, the burden of student loans far and above those required for an engineering degree, the finances required to move into practice when already buried in debt at the end of residency - these things cannot be compared apples-to-apples with the life you've chosen.

As the previous poster noted, Ob-Gyns (as well as most other physicians) do not have the luxury of choosing a suburban office, fewer hours and less money to trade off for enjoying flexibility and family time. If it were a simple 40,000/year pay cut to gain those things of which you speak, it would doubtless be an easy choice for most. That just isn’t an option. The taking-of-responsibility of which you mentioned precludes such a thing. Beyond that, nobody (in their right mind) would choose Ob-Gyn for the money. There are many more painless ways of earning a living. For the majority of us, we chose this path because we care deeply and feel something akin to this being our "calling". So while it is nice to make a good living (and begin digging out from under the mountain of debt), the money wasn’t the motivation for doing the job in the first place and so it also isn’t the reward which you and many others assume. It is a by-product. Part of that taking responsibility means giving up the freedom of leaving "the office" and not having to worry about it until walking back in, it means working the longer hours to see those last two patients that needed to be worked in even though it means missing your kid’s ball game when you either don’t need the money or will actually be losing money to see them. That last part may sound absurd but I assure you that there are times when seeing a patient literally means taking a financial loss.

This is simply a forum for those of us experiencing this path to share the difficulties, triumphs, experiences and realities with one another. Those of us frequenting this forum are coming here to better ourselves through taking lessons and/or solace and relief from the stories and camaraderie of our peers. We know we are fortunate to have medicine as our career. We value our patients. But we are also human. So we do take responsibility for our career choice and that is why we work very hard to not let our exhaustion and burn-out bleed through to be seen and/or experienced by others, especially those whom we’ve dedicated ourselves to providing healthcare. But the human condition does not except physicians and it was that to which Dr. Whoo was speaking. It was at the behest of a commenter and not offered as an excuse but as an explanation.

The post and comments offer some fascinating thoughts. I was interested in what Marce said, and although I considered myself in the healthy, realistic 30% she would likely peg me in the crazy doula set simply because I had a doula and birth plan (and did just fine with no drugs.)

Here's the thing, though, for most labors in my area the OB is not really as relevant as the nurse. This is our health care system in action. My labor was fine, the OB showed up at the end and stayed calm when the nurse wanted to send me off to the OR. A friend told the nurse over and over she needed to push, was blown off by said nurse until the anesthesiologist came in and said "you idiot, she's complete", and had a blue baby who didn't move one half of his body until 6 months old.

I only know of two "bitter" OB/GYNs online -one being OB/GYN Kenobi and the other a man. IRL, there is only one bitter OB that comes to mind. He constantly posts on facebook about having to stay over for another delivery or has to work in the clinic. He loves surgery. Too bad he can't just to robot hysts all the time.

Everyone else seems well adjusted and happy. One has been doing it for 30+ years. That was my n=1 example. Hopefully, I won't turn into a bigger misanthrope (misogynist would probably be better fitting) by the time I'm on OB.

OB/GYNs have the option of working part-time. That's very common in my area.

Doesn't matter to me as a patient, as IME they're inadequate primary care physicians. After a truly terrible (non-birth) experience I'll never see one again unless I'm on my deathbed with a GYN problem. Even then, I'd request a general surgeon, if possible. Yes, it was a group of female OB/GYNs with which I had the poor series of experiences. It wasn't possible to see how burned out and bitter my physician was until she royally screwed up and tried to cover her tracks by blaming me.

I am sure that OB-GYN's have to put up with a lot of stress, but then all of us in medicine do. I had a horrible experience rotating through OB-GYN. I happened to be pregnant at the time. I had awful nausea and vomiting during the rotation. I often had to go puke in between seeing patients. It is difficult to have time to go eat sometimes. As a result, I began to lose a significant amount of weight. My actual OB-GYN who was treating me told me that I needed to watch my weight or it would adversely affect my pregnancy. I tried to eat more. The female residents on the rotation, ganged up on me one day and told me that I was eating too much. They did not know that I was puking in the bathroom or that my OB told me I needed to watch my weight. They definitely made me feel like the unpopular girl being ostracized by the popular girls. It's ironic that the very profession who should be sensitive to needs of pregnant women were mocking me.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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